Many Tricare beneficiaries can’t find doctors

Apr. 3, 2013 - 02:04PM
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More than one-third of Tricare Standard beneficiaries have trouble finding a doctor who takes Tricare — and the situation is even worse for Standard users who live in areas served by Tricare Prime, a new government report finds.

In a review of Tricare customer surveys from 2008 to 2011, the Government Accountability Office found that Tricare Standard beneficiaries said they often have problems finding primary care physicians or specialists because providers don’t accept Tricare or have stopped taking new Tricare patients.

The GAO’s review of provider surveys determined that while six in 10 physicians accepted new Tricare patients, more than 20 percent who did not said it was because they had never heard of the military health care program.

Fourteen percent said they did not take Tricare because of low reimbursement rates and 10 percent cited past problems with claims as reasons for severing their relationships with Tricare.

The research confirmed what Tricare Standard users have long suspected: Acceptance of Tricare in the civilian medical community has dropped over time.

“Civilian physicians’ acceptance of any new Tricare patients has decreased from about 76 percent in 2005 to 2007 to an estimated 70 percent in 2008 to 2011,” according to the GAO.

Hardest hit in terms of access are Tricare Standard users who live in Tricare Prime Service Areas — 81 percent of all Standard beneficiaries, the report noted. About 27 percent of Standard beneficiaries in Prime Service Areas said they had trouble finding a regular doctor, while only 19 percent who live outside areas serviced by Prime reported problems.

Those living in northeastern Texas and central and southern coastal California faced the biggest challenges finding a doctor: In the California areas, less than half of doctors — 45 percent — were accepting new Tricare patients. In the Texas area, the figure was 53 percent.

“In each of these areas, although almost all civilian providers were accepting new patients, less than half were accepting new Tricare patients,” GAO analyst Debra Draper wrote. “In most of these areas, civilian providers most often cited reimbursement concerns as the reason why they were not accepting new Tricare patients.”

The report also found that among doctors, awareness and acceptance of Tricare differed by specialty, with mental health specialists ranking the lowest in accepting new Tricare patients.

According to the GAO, only 39 percent of mental health care providers said they were accepting new Tricare patients, compared to 67 percent of primary care providers and 77 percent of civilian specialty care providers.

The report made no recommendations. In response to the study, Assistant Secretary of Defense for Health Affairs Dr. Jonathan Woodson said he concurred with its findings.